HESI Prep: Neurologic and Sensory Systems

Which lobe of the cerebrum includes the Broca speech center?

Frontal lobe - The Broca speech center is located in the frontal lobe and is responsible for the formation of words into speech. The parietal lobe aids in processing of spatial awareness and receiving and processing information about temperature, taste, and touch. The primary visual center is in the occipital lobe. The auditory center for interpreting sound is present in the temporal lobe.

Which action puts a client at risk for low back injury and pain?

Smoking tobacco - Smoking is a risk factor for low back pain and injury because it causes constriction of blood flow. Regular swimming exercise helps strengthen the back. Vitamin D supplementation works with calcium to strengthen the musculoskeletal system. Prolonged sitting can be augmented with a foot stool and ergonomic chair to support the back.

Punctal occlusion is performed after the administration of eyedrops to prevent which from occurring?

Systemic absorption - Punctal occlusion prevents systemic absorption of the medication. For example, systemic absorption of beta-blockade used to treat glaucoma can affect heart rate and blood pressure. Punctal occlusion does not prevent tearing, infection, or allergic reaction.

The nurse is teaching a client how to care for an eye infection. Which statement by the client reflects understanding of the teaching?

"Wash your hands before and after washing and treating the eye." - The nurse will instruct clients to wash his or her hands before and after treating the eye to prevent spreading or worsening the infection. Clients will be instructed to wash the noninfected eye first because this prevents spreading infection from the infected eye to the noninfected eye. Clients will be instructed to keep eyes open, rather than closing them, after administering the medication because squeezing the lids shut can push the solution out of the eye. Clients need to avoid allowing the antibiotic solution to come into contact with any surface to prevent contamination.

Which Glasgow Coma Scale score would the nurse give a client who does not open the eyes to any stimulus, only makes incomprehensible sounds and moans, and extends the arm at the elbow with adduction and internal rotation of the arm at the shoulder?

5 - This client scores a 5 on the Glasgow Coma Scale: 1 point for not opening the eyes to any stimuli, 2 points for only making incomprehensible sounds, and 2 points for abnormal extension of the arm.

Which intervention would the nurse implement to prevent precipitating a painful attack in a client with tic douloureux?

Avoid walking swiftly past the client. - Tic douloureux is also called trigeminal neuralgia and has a characteristically severe stabbing pain to one or both sides of the face. The nurse should avoid walking swiftly past the client because drafts or even slight air currents can initiate pain. The client may assume any position of comfort, but pressure on the face while in the prone position may trigger an attack. Although clients may modify their procedure for oral hygiene, oral hygiene is not discontinued. The client should avoid massaging the face because the massage may trigger an attack.

Which reflex is the nurse testing when using a dull object to stroke from the lateral sole of a client's foot upward to the great toe?

Babinski - This is the description of how to elicit the Babinski reflex. If it is present in adults, it may indicate a lesion of the pyramidal tract. The Babinski reflex is expected in newborns and disappears after 1 year. The Moro (startle) reflex is expected in newborns. It disappears between the third and fourth months; if present after 4 months, neurological disease is suspected. The stepping reflex is expected in newborns. It disappears at about 3 to 4 weeks after birth and is replaced by more deliberate action. The cremasteric is a superficial reflex that tests lumbar segments 1 and 2. Stimulation of this reflex is useful in initiating reflex emptying of the spastic bladder after a spinal cord disruption above the second, third, or fourth sacral segment.

Which type of reflex is the nurse performing in the figure? (tapping on top of knee)

Patellar reflex - Patellar reflex, performed in this figure, is done by striking the patellar tendon just below the patella. The biceps reflex is performed with the client's arms partially flexed and palms up, by placing the thumb over the biceps tendon. The triceps reflex is performed by striking the triceps tendon above the elbow while the client's arm is flexed. The brachioradialis reflex is performed by striking the radius 3 to 5 cm above the wrist while the client's arm is reflexed.

Which action would the nurse take for a client who is having a tonic-clonic seizure?

Taking measures to prevent injury - Protecting the client from injury is the immediate priority during a seizure. Elevating the head of the bed would have no effect on the client's condition or safety. Restraining the client's arms and legs could cause injury. Placing a tongue blade or other object in the client's mouth could damage the teeth.

Which nursing action would be included in the plan of care for a client scheduled to have a computed tomography (CT) scan of the brain?

Telling the client what to expect during the test - Knowing what to expect decreases anxiety. Routine medications are not withheld. A sedative is not necessary for a CT scan. Removing metal is for a magnetic resonance imaging (MRI) test.

While conducting an eye examination, the ophthalmologist shines a light into the client's pupil and observes that there is a slow recovery of the pupil size. Which muscular atrophy is responsible for this condition?

The iris dilator muscle - The iris dilator muscle is involved in the dilation of the pupil. Atrophy of the iris dilator muscle is responsible for slow recovery of the pupil size after a light is shone in the client's pupil. The iris sphincter muscle is involved in pupil constriction. Atrophy of this muscle may cause a failure to constrict the pupil when a light is shone on it. The medial rectus muscle is an extraocular muscle that helps in the movement of the eye. The lateral rectus muscle is also an extraocular muscle that is unassociated with pupil dilation.

Which test is used to diagnose diseases of the vestibular system?

Caloric reflex test - The caloric reflex test is a test of the vestibulo-ocular reflex that involves irrigating cold or warm water into the external auditory canal. It is used to check for nystagmus, nausea and vomiting, falling, or vertigo, conditions associated with diseases of the vestibular system. The Rinne test is a tuning fork test that aids in differentiating between conductive and sensorineural hearing loss. Pure-tone audiometry determines the client's hearing range in terms of decibels (dB) and Hertz (Hz). This test is used to diagnose conductive and sensorineural hearing loss. An auditory brainstem response test provides diagnostic information related to acoustic neuromas, brainstem problems, and strokes.

Upon entering a client's room, the nurse sees the client exhibiting seizure activity. Which is the first action the nurse would take?

Assess the client's airway. - Ensuring an airway is the first action in an emergency response to any client. Placing pads on the side rails during the procedure is too late; protecting the airway and client are priority. The health care provider will be notified as soon as the nurse ensures the client's safety and that she or he has a patent airway. The nurse would not leave the client during a seizure.

Which physiological response is the likely cause of a client developing hydrocephalus 2 weeks after cranial surgery for a ruptured cerebral aneurysm?

Blocked absorption of fluid from the arachnoid space - Residual blood from the ruptured aneurysm may have blocked the arachnoid villi, interrupting the flow of CSF and resulting in hydrocephalus. Vasospasm is a protective response during the active bleeding process; it does not cause hydrocephalus. The Broca center is not directly affected; even if it were, there is no relationship to the development of hydrocephalus. The production of cerebrospinal fluid is not increased in this situation; increased production may result when there is a tumor of the choroid plexus.

Which ocular symptom would the nurse expect a client with a diagnosis of dry age-related macular degeneration to report?

Loss of central vision - The main characteristic of dry age-related macular degeneration is loss of central vision, which is gradual. Primary angle-closure glaucoma causes pain. Blurred vision may be caused by a refractive error. Loss of peripheral vision does not occur with macular degeneration; peripheral vision loss can occur with glaucoma.

Which clinical manifestations are found in the client diagnosed with stage 3 of Parkinson disease? Select all that apply. One, some, or all responses may be correct.

Masklike face, Postural instability, Increased gait disturbances - Parkinson disease is a progressive neurodegenerative disease that is one of the most common neurological disorders of older adults. Stage 3 of Parkinson disease is characterized by postural instability and increased gait disturbances. The "masklike" face begins in stage 2 and continues in stage 3. Akinesia is manifested in stage 4 of the disease. In stage 1 of Parkinson disease, only unilateral limb involvement is seen, but it progresses to bilateral in later stages.

A client with a cervical injury reports the sudden onset of a severe headache and nasal congestion. For which clinical manifestations would the nurse assess?

Suprapubic distention - Suprapubic distention is a symptom of autonomic dysreflexia, which is commonly precipitated by a distended bladder. Increased spinal reflexes and adventitious breath sounds are not associated with the symptoms of autonomic dysreflexia. The blood pressure increases suddenly with autonomic dysreflexia.

The nurse is caring for a client 1 week after the client experienced a spinal cord injury at the T3 level. Which short-term goal is appropriate in planning care for this client?

"The client will carry out personal hygiene activities." - If the client performs personal hygiene activities, it will help maintain a positive identity. Understanding limitations, considering lifestyle changes, and performing independent ambulation are longer-term goals.

A client reports a severe throbbing unilateral headache, nausea, and intolerance to light and sound. Arrange the pathophysiologic events in chronologic order.

Throbbing and unilateral headaches are often associated with nausea or sensitivity to light, sound, or head movement and may indicate migraine headaches. Vascular changes occur after the stimulation of the hyperexcitable neuronal pathway. Activation of the trigeminal nerve pathways contributes to the activation of nociceptors. Dilation of cerebral arteries will help in release of prostaglandins. Vasodilation, in turn, allows prostaglandins and other intravascular molecules to extravasate, contributing to widespread tissue swelling and the sensation of throbbing pain.

Which group has the highest rate of meningococcal infection?

Young adults - Those between the ages of 16 and 21 years, many of whom are young adults, are most at risk for meningococcal infection and are the main target group for vaccination. Infants and toddlers can contract meningococcal infection, but it is not as prevalent in these groups as in the young adult population. Older adults do not have a higher prevalence of meningococcal infection than young adults; however, individuals in this group who are immunocompromised may benefit from receiving the vaccination or boosters.